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Results of a new study suggest that nearly one in 10 sexually active teens have same-sex partners, which is almost twice as many as previous research studies have found.1

Researchers at the New York City Department of Health and Mental Hygiene looked at results from the 2005–2007 New York City Youth Risk Behavior Surveys, which included responses from more than 17,000 teens in the city. Their analysis indicates that teens that had sex with only their own gender or with both genders were more likely to engage in risky sexual behaviors, putting themselves at greater risk for sexually transmitted diseases (STDs).

Past research indicates that youth who have sexual experiences with partners of the same sex are vulnerable in that they report high rates of depression, suicidal ideation, substance abuse, and experience with violence, among other issues,2,3 says Preeti Pathela, DrPH, research scientist in the Department of Health's Bureau of Sexually Transmitted Disease Control and lead author of the current study. Past findings suggest that the subset of adolescents who have partners of both sexes might be more prone to these experiences and outcomes, she says.4 However, analyzing information on this group has not been easy because large sample sizes are needed to draw generalizable conclusions; therefore, studies looking at these issues often have not separated males and female respondents or they have combined respondents with bisexual and exclusively homosexual behavior in order to yield larger groups, she notes.

"In New York City, we are fortunate to have biennial surveys of large numbers of adolescents that could provide us with data," Pathela notes.

Analyze the results

To perform the study, researchers looked at results from the 2005-2007 New York City Youth Risk Behavior Surveys, which look at different behaviors among high school students. Of 15,009 students who answered the question on sexual intercourse, 55.2% (3,898 of 7,021) of male and 43.8% (3,501 of 7,988) of female adolescents reported that they had ever had sex.

Similar numbers of sexually active male and female adolescents (3.2%) reported only same-sex behavior, but fewer male than female adolescents reported both-sex partners (3.7% versus 8.7%; P < .001). Male adolescents with both-sex partners reported a higher prevalence of sexual risk behaviors than male adolescents with only opposite-sex or only same-sex partners. For example, male adolescents with both-sex partners were much less likely to report using a condom at last sex (44.1%) compared with those with opposite-sex partners (79.8%; P = .0002). Female adolescents with both-sex or only same-sex partners also reported a higher prevalence of risk behaviors than female adolescents with only opposite-sex partners, researchers note. Teen girls were more likely to report the use of alcohol/drugs with the last sexual encounter if they had both-sex partners (23.0%) or only same-sex partners (22.3%) than if they had only opposite-sex partners (10.0%). Adolescents with both-sex partners reported a marked prevalence of dating violence and forced sex (males: 34.8% partner violence, 31.6% forced sex; females: 35.8% partner violence, 34.1% forced sex).

What's your approach?

Many adolescents in the New York City survey with only same- or both-sex partners (38.9%) self-identified as straight. That is why clinicians should inquire about behaviors, and not identity, to determine teen's risks for STDs, the researchers note. Education about STDs should include information appropriate for youth with same-sex partners, they add.

Getting clinicians up to speed in dealing with sexual orientation might be a challenge. According to information presented at the 2009 Contraceptive Technology conference, 70% of pediatricians in one survey did not report addressing the issue.5

To make sure your office is "teen-friendly" when it comes to sexual behaviors, the California Adolescent Sexual Health Work Group suggests offering sexual health education materials with age-appropriate language in the waiting room that are inclusive of a diverse audience. Also check your intake/history forms and questionnaires to make sure it has gender-inclusive language.

Talk with staff members to be sure they are careful to avoid making assumptions about gender or sexual orientation with teen patients. Staff should be ready to maintain sensitivity for the sexual orientation, family structure, and lifestyle choices of all patients and their loved ones, the work group recommends.6